This cutting edge hair loss treatment is a repurposed drug from the
1990s
[March 20, 2025]
By MATTHEW PERRONE
WASHINGTON (AP) — The latest trend in treating hair loss may sound
familiar — essentially, it's a repurposed drug first popularized in the
1990s.
Back then, TV viewers were inundated with ads for Rogaine, a sticky
topical solution that could help treat thinning hair when applied to the
scalp.
Now dermatologists are increasingly prescribing the drug, known
generically as minoxidil, in low-dose pills to help men and women
maintain or regrow hair.
The practice follows several recent studies suggesting the ingredient
works as well — or possibly better — when swallowed, rather than applied
to hair follicles on the head. Telehealth companies are also driving new
demand by offering a quick, easy way to get a prescription and have the
pills shipped directly to customers' doors.
Here’s a look at the drug:
A retro approach to hair loss
Minoxidil was originally developed as a pill to treat high blood
pressure in the 1970s. Researchers noticed that some patients taking it
experienced increased hair growth as a side effect.
Rogaine was approved by the Food and Drug Administration in 1988, the
first drug to win the agency’s endorsement for male pattern baldness.
Studies showed that men on the medication, which was applied directly to
the scalp, had a slower rate of hair loss and, in some cases, regrew
hair.
Starting in 1991, a lower dose was approved for women and the brand was
aggressively marketed as an over-the-counter medication on TV and in
print.
The drug’s ability to slow hair loss is likely related to its effect on
blood circulation, according to experts.
“By increasing blood flow to the scalp it signals hairs to stay in their
growth phase for longer,” said Dr. Adam Friedman, chair of dermatology
at George Washington University. “We’re trying to keep those hairs in
that growth phase as long as possible.”
A recent consensus paper by more than 40 U.S. and international
dermatologists concluded that minoxidil pills are effective and often
more convenient and affordable than the liquid formulation.
Patients prefer the pill
There's little research comparing the two forms of minoxidil, but many
dermatologists believe the drug works better as a pill.
At a chemical level, minoxidil is absorbed more directly when digested
in the gut than when applied to the hairline. It’s also more convenient,
with patients taking the drug by mouth once a day, instead of applying
the liquid once or twice daily using a dropper.
“As you can imagine, that can be rather onerous,” said Dr. Susan Taylor
of the University of Pennsylvania. “Although people often
enthusiastically begin therapy— and even see results — after a while
there are many who drop off.”
The doses prescribed for oral use are also very low. Dermatologists
often direct men to take one half of the lowest-dose pill; women may
only need a quarter of a pill.
Those low doses can also reduce the chances for side effects, which can
include dizziness, rapid heartbeat and swollen legs. The drug isn’t
recommended for people with a history of heart issues or who are
pregnant or breastfeeding.
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 The only other FDA-approved
medication for hair loss is finasteride, sold under the brand name
Propecia, a drug that blocks a byproduct of testosterone that
triggers hair loss in men. That drug is generally considered more
effective than minoxidil, but it can occasionally cause troubling
sexual side effects, including erectile dysfunction. For optimal
results, some dermatologists prescribe the two drugs in combination.
Why aren’t minoxidil pills FDA-approved for hair loss?
In short, because there’s very little money to be made.
Minoxidil's patent has expired and it is now available as a low-cost
generic medication. That means drugmakers have little financial
incentive to spend millions on the new studies that would be needed
to win FDA approval for hair loss.
“For a drug like oral minoxidil — which is as old as dirt at this
point — there are no reasons to do that,” said Friedman. Like other
dermatologists, Friedman gives hair-loss patients a prescription for
the pills intended to treat blood pressure, a practice known as
off-label prescribing.
The upside for patients is that minoxidil is extremely affordable,
with some pharmacies offering a month’s supply for less than $5.
“Not a single patient has complained to me about the cost of this
medication, which is extremely rare,” said Dr. Luiz Garza of Johns
Hopkins University.
Telehealth firms open up access
The vast majority of doctors prescribing minoxidil for hair loss are
dermatologists, who often turn to older drugs off-label for various
hair and skin conditions.
A survey of U.S. dermatologists published last year found 80%
reported prescribing oral minoxidil. But with only about 12,000
dermatologists in the U.S., some patients may have trouble finding a
provider.
Telehealth providers like Hims and Ro say they are helping fill the
gap. Their business model offers patients quick access to the
medications they are seeking, often after simply filling out a
questionnaire about their medical history, medications and treatment
goals. The information is reviewed by a health provider who can
quickly approve a prescription, assuming there are no red flags.
Hims and Ro each say that their providers won't prescribe minoxidil
for patients who have complicating health conditions or
prescriptions that could negatively interact with the drug. In some
cases, patients may be referred for an office visit.
Many dermatologists say patients are better served by an in-person
appointment, where a doctor will usually take a blood pressure
reading, evaluate their medical history, prescriptions and discuss
the drug's side effects.
“I’m not a proponent of going to an online service,” said Taylor. “I
recommend seeing your board-certified dermatologist who’s trained,
who knows the data and can evaluate all of you.”
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